title: Participant experiences and facilitators and barriers to pill use among men who have sex with men in the iPrEx pre-exposure prophylaxis trial in San Francisco.
abstract: In 2010, the iPrEx study demonstrated efficacy of daily emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) pre-exposure prophylaxis (PrEP) in reducing HIV acquisition among men who have sex with men. Adherence to study product was critical for PrEP efficacy, and varied considerably, with FTC/TDF detection rates highest in the United States. We conducted a qualitative study to gain insights into the experiences of iPrEx participants in San Francisco (SF) where there was high confirmed adherence, to understand individual and contextual factors influencing study product use in this community. In 2009 and 2011, we conducted focus groups and in-depth interviews in 36 and 16 SF iPrEx participants, respectively. Qualitative analyses indicate that participants joined the study out of altruism. They had a clear understanding of study product use, and pill taking was facilitated by establishing or building on an existing routine. Participants valued healthcare provided by the study and relationships with staff, whom they perceived as nonjudgmental, and found client-centered counseling to be an important part of the PrEP package. This facilitated pill taking and accurate reporting of missed doses. Adherence barriers included changes in routine, side effects/intercurrent illnesses, and stress. Future PrEP adherence interventions should leverage existing routines and establish client-centered relationships/ environments to support pill taking and promote accurate reporting.
authors.affiliation: 1 Bridge HIV, San Francisco Department of Public Health , San Francisco, California.
authors.forename: Hailey J
authors.initials: HJ
authors.lastname: Gilmore
authors.forename: Albert
authors.initials: A
authors.lastname: Liu
authors.forename: Kimberly Ann
authors.initials: KA
authors.lastname: Koester
authors.forename: K Rivet
authors.initials: KR
authors.lastname: Amico
authors.forename: Vanessa
authors.initials: V
authors.lastname: McMahan
authors.forename: Pedro
authors.initials: P
authors.lastname: Goicochea
authors.forename: Lorena
authors.initials: L
authors.lastname: Vargas
authors.forename: David
authors.initials: D
authors.lastname: Lubensky
authors.forename: Susan
authors.initials: S
authors.lastname: Buchbinder
authors.forename: Robert
authors.initials: R
authors.lastname: Grant
mesh_terms: D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D000998:Antiviral Agents / Q000008:administration & dosage*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D004311:Double-Blind Method; D000068679:Emtricitabine; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control*; D015497:HIV-1; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D063065:Organophosphonates / Q000008:administration & dosage*; D036301:Qualitative Research; D012307:Risk Factors; D012495:San Francisco; D000068698:Tenofovir; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000998:Antiviral Agents; D063065:Organophosphonates; D003841:Deoxycytidine; D000068698:Tenofovir; D000068679:Emtricitabine; D000225:Adenine